Patna, Nov. 5 -- There is some 'very disturbing' news for health planners in Bihar. Of the 98 cases of poliomyelitis detected in Bihar till October 30 this year, 93 children had been administered seven doses of oral polio vaccine (OPV). One child had been given three doses and the vaccination status of the other four kids is unknown. Not surprising therefore, those in the know of things are now passing the buck.

The data, collected under the National Polio Surveillance Programme (NPSP) of the World Health Organisation (WHO), has baffled experts, many of whom have started questioning the usefulness of the OPV. "The latest statistics of polio cases in Bihar is perplexing. Either the affected children suffer from serious immunity deficiency or the OPV has failed to produce required immunity in them," said Dr Gopal Krishna, State immunisation officer. Dr Hemant Shukla, in-charge of the NPSP and WHO representative in Bihar, evaded queries on the data saying: "I am not the authorised person to comment on the issue." Principal Health Secretary CK Mishra could not be contacted despite repeated efforts by HT.

The WHO provides technical support to the polio elimination programme while the United Nations International Children's Emergency Fund (UNICEF) takes care of the social mobilisation aspect of the exercise. The State government executes the work as per the directives issued by the Union Ministry of Health and Family Welfare. "The agencies involved in the programme are groping in the dark," said a senior doctor on condition of anonymity. " Their hit and trial tactics to eradicate the debilitating disease has failed to deliver the goods, " he added. In 2007, when they concentrated on eliminating P1 polio virus, the P3 virus went wild and affected 459 kids. In 2009, when they focused their attention on the P3, the P1 afflicted 34 children.

The alarming rate of growth registered in polio cases also raises serious questions on the quality of teams deployed or whether, all teams shown as deployed are actually there or not. Data now suggests that when anti-polio activity was said to have been intensified in north Bihar, the number of cases abnormally increased in central parts of the State. And when they came to central Bihar, the number of those afflicted rose significantly in north Bihar. In the current year, Saharsa district has reported maximum number of cases (22), followed by Khagaria (15) and Patna (13), the doctor said.

The agencies have also tried all types of vaccines: monovalent, trivalent etc. to contain the disease. Dr SP Srivastava, former head of department (HoD) of pediatrics, Patna Medical College and Hospital (PMCH), believes that one of the major factors for recurrence of the cases is that the vaccine has failed to act on the changing genetic mutation of the virus.

Dr Sujit Kumar Sinha, president of the Indian Academy of Paediatrics (IAP), Patna chapter, believes that immunity status of the child should be examined before the administration of the OPV. Some other doctors blame poor sanitation and population density for the high incidence of polio. The issue is being taken up at the two-day meeting of the Indian Expert Advisory Group on polio, beginning in New Delhi on Thursday.

There was something of an epidemic of poliomyelitis, or polio for short, in the early 1950s, but it is an old disease; both my parents had mild cases around World War I. In its most severe form it could paralyze or deform the spine, legs or lungs. Nobody knew how the virus was transmitted; public swimming pools came under suspicion for a time, and September was known to be the worst month of the "polio season." And so there was polio insurance, which covered families for the cost of such treatment as was available. But little could be done, then or now, besides physical therapy on paralyzed limbs or the purchase of a respirator machine-known as an "iron lung" -- for paralyzed breathing muscles. Polio's most famous victim was Franklin D. Roosevelt, a paraplegic. He encouraged the work of the March of Dimes, which funded research in the disease, and it was his image that appeared on the new dime issued in 1946. Finally, in 1955, Dr Jonas Salk introduced an effective vaccine, followed by another from Dr. Albert Sabin a few years later, and a nationwide vaccination program transformed polio into a bad memory.

The Polio Crusade

THE POLIO CRUSADE IN AMERICAN EXPERIENCE A GOOD VIDEO
THE STORY OF THE POLIO CRUSADE pays tribute to a time when Americans banded together to conquer a terrible disease. The medical breakthrough saved countless lives and had a pervasive impact on American philanthropy that ...
Continue reading..http://www.pbs.org/wgbh/americanexperience/polio/

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WHO WE ARE

We are a non-profit civil organization legally incorporated in Mexico City, on January 8, 2004. Our main goal is to spread information on Post-Polio Syndrome by all possible means, and to offer help to any person suffering from Poliomyelitis or Post-Polio Syndrome.

Fortunately, thanks to science and medical research, we know the etiology of Post Polio Syndrome and its different pathological manifestations. This knowledge will help persons who had Poliomyelitis to make decisions to avoid or to delay the first’s signs of Post-Polio.

One of the Post-Polio Association Litaff A.C. goals is to provide information onpreventive medicine through medical articles available by free downloads, organization of conferences and seminars,meditation specialized workshops and access to an excellent Cromotherapy treatment for Post-Polio Syndrome and Fibromyalgia, access to nutrition programs, etc.

One of the multiple goals of our association is to help people suffering from Poliomyelitis sequels, Chronic Fatigue or Fibromyalgia

to modify or to improve their life quality.

We base our advice on the experience of specialists and their medical recommendations. One really important goal always present in our minds is to help and support the family and friends of those who suffer from Post-Polio Syndrome, Fibromyalgia and Chronic Fatigue, because they represent a fundamental support for them. We are able to provide them with reliable information and psychological help.

We are concerned about the architectonic barriers in our cities and we’re working every day to improve and make the movements of any person with a motor incapacity easier. In this regard, we do have a good support from our authorities and from the society. Likewise, we offer some good job opportunities with flexible schedules, so every person has a chance to adapt.

We invite every poliomyelitis survivor, every person suffering from Fibromyalgia and/or Chronic Fatigue to join this association through this page, so we can share our experiences and we can also be able to extend the network of families and friends of Post-Polio Litaff A.C. through its chat room, its discussion forum and its conferences. We invite you too, of course, to benefit of all the advantages we offer.

We do consider that this Website could be a valuable media for spreading all the information gathered on Post-Polio Syndrome and, of course, an excellent way of knowing each person affected and helping each other.

This could be done in different ways: direct economical contribution, professional medical attention, or even by donations of wheel chairs, crutches, scooters, and any aid you could think of.

Any doctor who wishes to join us to help our members, any volunteer who wants to help in the activities that Post Polio Litaff A.C.Organizes every day is absolutely welcome.

Of course, we’re aware of the fact that our goals represent an incredible task. However, we do have great enthusiasm and spirit of solidarity that we are putting at the service of this noble cause, inspired by The Supreme Power that makes it All Possible.

As a Post-Polio survivor, I send this message to all those who suffered from Poliomyelitis. I really want to tell you that you are not alone, we’re numerous persons suffering from this Syndrome and, in the same way we fought the Poliomyelitis in our childhood, we’re going to get together and fight together the battle against this still unknown Syndrome. Together, we will force the world to know about it.

In case you’re already a Post-Polio Syndrome victim, the Post-Polio Association Litaff A.C. is here, so that together we can join ours forces and enthusiasm to get the necessary support.

You are all welcome to become part of the association.

“From this day, let’s try to live one day at a time without forcing ourselves to do more than our body is able to” and let’s live with a positive attitude facing forward this event that we can’t modify now. That’s why accepting it with a positive attitude will help any person suffering from it.

Post-polio syndrome (PPS) refers to the late development of new neuromuscular symptoms in previously stable poliomyelitis patients.

Whether psychological disturbance plays a role in the manifestation of symptoms in these patients is unclear. We examined 22 patients fulfilling the clinical criteria for PPS with the Minnesota Multiphasic Personality Inventory-II (MMPI-II), (Beck Depression Inventory, Spielberger State-Trait Anxiety Scales, Chapman and Chapman Psychosis-Proneness Scales,)

Fatigue Scales, a neurobehavioral rating scale, and Cognitive Symptoms Self-Report Scales. The overwhelming majority of scale scores were within normal limits, and there was no indication that psychopathologic symptoms were associated with the development or severity of new muscle weakness in PPS patients.

Women with PPS had significantly more somatic complaints, but were less socially isolated than men with PPS. This study confirms that the development or severity of new muscle weakness in carefully diagnosed PPS patients is not due to, or influenced by, underlying psychopathology.

The Lancet Neurology, Volume 9, Issue 6, Pages 634 - 642, June 2010
doi:10.1016/S1474-4422(10)70095-8Cite or Link Using DOI
This article can be found in the following collections: Infectious Diseases (Neurological infections, Infectious diseases-other); Neurology (Neurological infections, Neurology-other, Neuromuscular disorders)
Management of postpolio syndrome
Henrik Gonzalez MD Tomas Olsson MD b, Kristian Borg MD a
Summary
Postpolio syndrome is characterised by the exacerbation of existing or new health problems, most often muscle weakness and fatigability, general fatigue, and pain, after a period of stability subsequent to acute polio infection. Diagnosis is based on the presence of a lower motor neuron disorder that is supported by neurophysiological findings, with exclusion of other disorders as causes of the new symptoms. The muscle-related effects of postpolio syndrome are possibly associated with an ongoing process of denervation and reinnervation, reaching a point at which denervation is no longer compensated for by reinnervation. The cause of this denervation is unknown, but an inflammatory process is possible. Rehabilitation in patients with postpolio syndrome should take a multiprofessional and multidisciplinary approach, with an emphasis on physiotherapy, including enhanced or individually modified physical activity, and muscle training. Patients with postpolio syndrome should be advised to avoid both inactivity and overuse of weak muscles. Evaluation of the need for orthoses and assistive devices is often required.

Poliomyelitis

Erradicación

History of polio

In the early 20th century, polio was one of the most feared diseases in industrialized countries, paralysing thousands of children every year. Soon after the introduction of effective vaccines in the 1950s and 1960s however, polio was brought under control and practically eliminated as a public health problem in these countries.

It took somewhat longer for polio to be recognized as a major problem in developing countries. Lameness surveys during the 1970s revealed that the disease was also prevalent in developing countries. As a result, during the 1970s routine immunization was introduced worldwide as part of national immunization programmes, helping to control the disease in many developing countries.

In 1988, when the Global Polio Eradication Initiative began, polio paralysed more than 1000 children worldwide every day. Since then, 2.5 billion children have been immunized against polio thanks to the cooperation of more than 200 countries and 20 million volunteers, backed by an international investment of more than US$ 8 billion.

Today, polio has been eliminated from most of the world and only four countries remain endemic. In 2009, fewer than 2000 cases were reported for the entire year.

Use this interactive timeline to trace the history of polio from 1580 B.C. to the present.

A 41-year-old man developed an acute illness at the age of 9 months during which, following a viral illness with headache, he developed severe weakness and wasting of the limbs of the left side. After several months he began to recover, such that he was able to walk at the age of 2 years and later was able to run, although he was never very good at sports. He had stable function until the age of 18 when he began to notice greater than usual difficulty lifting heavy objects. By the age of 25 he was noticing progressive difficulty walking due to weakness of both legs, and he noticed that the right calf had become larger. The symptoms became more noticeable over the course of the next 10 years and ultimately both upper as well as both lower limbs had become noticeably weaker.

On examination there was wasting of the muscles of upper and lower limbs on the left, and massively hypertrophied gastrocnemius, soleus and tensor fascia late on the right. The calf circumference on the right exceeded that on the left by 10 cm (figure1). The right shoulder girdle, triceps, thenar eminence and small muscles of the hand were wasted and there was winging of both scapulae. The right quadriceps was also wasted. The wasted muscles were also weak but the hypertrophied right ankle plantar flexors had normal power. The tendon reflexes were absent in the lower limbs and present in the upper limbs, although the right triceps was reduced. The remainder of the examination was normal.

The patient's legs, showing massive enlargement of the right calf and wasting on the left

Questions

1

What is that nature of the acute illness in infancy?

2

What is the nature of the subsequent deterioration?

3

What investigations should be performed?

4

What is the differential diagnosis of the cause of the progressive calf hypertrophy?

Answers

QUESTION 1

An acute paralytic illness which follows symptoms of a viral infection with or without signs of meningitis is typical of poliomyelitis. Usually caused by one of the three polio viruses, it may also occur following vaccination and following infections with other enteroviruses.1 Other disorders which would cause a similar syndrome but with upper motor neurone signs would include acute vascular lesions, meningoencephalitis and acute disseminated encephalomyelitis.

QUESTION 2

A progressive functional deterioration many years after paralytic poliomyelitis is well known, although its pathogenesis is not fully understood.2 It is a diagnosis of exclusion; a careful search for alternative causes, for example, orthopaedic deformities such as osteoarthritis or worsening scoliosis, superimposed neurological disorders such as entrapment neuropathies or coincidental muscle disease or neuropathy, and general medical causes such as respiratory complications and endocrinopathies.3

QUESTION 3

Investigations revealed normal blood count and erythrocyte sedimentation rate and normal biochemistry apart from a raised creatine kinase at 330 IU/l (normal range 60–120 IU/l), which is commonly seen in cases of ongoing denervation. Electromyography showed evidence of denervation in the right APB and FDI with polyphasic motor units and complex repetitive discharges, no spontaneous activity in the left calf and large polyphasic units in the right calf consistent with chronic partial denervation. Motor and sensory conduction velocities were normal. A lumbar myelogram was normal. Magnetic resonance imaging (MRI) scan of the calves is shown in figure2.

Axial T1 weighted MRI scan (TR 588 ms, TE 15 ms) of the calves, showing gross muscle atrophy and replacement by adipose tissue on the left, and hypertrophy of the muscles on the right, with only minor adipose tissue deposition

QUESTION 4

The differential diagnosis of the progressive calf hypertrophy is given in the box.

POLIO KILLS IN MINNESOTA

POLIO KILLS IN MINNESOTADEATH GIVES “NIPP IT CAMPAIGN” NEW EMPHASIS

The Associate Press on Tuesday April 14, 2009 the death of a woman infected with the live poliovirus used in the oral vaccine that was discontinued in the US nine years ago. The health department says the patient died with polio symptoms, but it's not known to what extent polio contributed to the death. The patient also had a weakened immune system and multiple health problems. The Minnesota department of health says the patient most likely became infected from someone who had received the live-virus vaccine before its use was stopped in the US.

Said Dr. Richard Bruno, chairperson of the International Post-Polio Task Force, "This sad death is the latest reminder that polio may be forgotten in the US, but that it is far from gone.”

Alarming Drops in Polio Vaccination in US Border States and Ports of Entry.

Unfortunately, rates of polio vaccination have decreased in the US despite six other US polio cases since 2005 -- five of them in Minnesota -- caused by poliovirus imported into the US, and despite polio last month breaking free of vaccination efforts in Africa, with Kenya and Uganda reporting their first polio cases and deaths in twenty years.

“The latest Centers for Disease Control data show drops in polio vaccination in twenty states and in ten large US cities," said Dr. Bruno, who is also director of The Post-Polio Institute at Englewood (NJ) Hospital and Medical Center. “CDC estimates that more than nearly one million US toddlers are unvaccinated.”

“Even Minnesota has had a decrease in polio vaccination, which is obviously disturbing,” said Dr. Bruno. “It is frightening that states with the largest drops lie next to Mexico and Canada, across whose borders the poliovirus is believed to have been imported into the US since 1997.” Seventy percent of the states that border Canada had drops in polio vaccination, as did Arizona, Texas and New Mexico.

City Children Living in Poverty Have Lowest Polio Vaccination Rates.

Dr. Bruno is also concerned about cities that are major points of entry into the US -- New York, Philadelphia, Houston and Seattle -- where drops in polio vaccination were also reported.

“Toddlers living in poverty have the lowest polio vaccination rates -- below 87% in Boston, Indianapolis, Memphis and Phoenix, and below 85% in Detroit, Houston and Seattle -- rates lower than in Western Pacific countries that include Cambodia, Mongolia and Vietnam,” said Dr. Bruno. "I'm worried that those who recently had polio in the US are canaries in the mine shaft."

"NIPP IT CAMPAIGN” Underscored by Minnesota Death. (Click on the photo for a pdf file.)

Rotary International has joined The International Post-Polio Task Force in the “National Immunization for Polio Prevention in Infants and Toddlers -- or 'NIPP IT' -- CAMPAIGN,” to prompt parents, healthcare professionals and state health officials to ensure that all American children receive all doses of the injectable, inactivated polio vaccine by age two.

“ The 'NIPP IT CAMPAIGN' is intended to raise awareness of the need for polio vaccination, to stop state legislatures from allowing parents to refuse vaccinations for their children because of “philosophically objections” to vaccines and hopefully 'nip' America's next polio epidemic in the bud,” said Dr. Bruno.

The polio vaccine has been a victim of its own success. Young parents do not vaccinate because they have not experienced the devastation, death and disability caused by diseases that vaccines eliminated, or are unaware that polio remains a scourge that is readily transportable from Africa, Pakistan, Afghanistan and India.

"With the ease of air travel, what will happen when a polio-infected individual lands in one of America's potential polio pockets, like New York City, and passes poliovirus to the estimated 24,000 infants and toddlers in that city who are not immunized?” asked Dr. Bruno .

Former First Lady Rosalynn Carter agreed, "Our country has come so far to be protected against polio through universal vaccination. We cannot afford to relax our efforts because polio is still a real problem in parts of the world and can easily be transported back to the U.S. We cannot risk a single child to this terrible disease."

“We must do more to vaccinate America's children against this deadly and disabling disease," said Bruno. "America's next polio epidemic could be just a car, bus or plane ride away."

POLIO SURVIVORS WHO CAN'T PAY FOR EVALUATION.

In the past, Englewood Hospital and Medical Center has reduced fees or written off the cost of treatment for needy patients, especially for those coming from overseas. However, with hundreds of polio survivors visiting The Post-Polio Institute each day via the Internet, and with the remarkable response to Dr. Bruno's book The Polio Paradox, increasing numbers of patients with limited financial resources are now asking for treatment at The Post-Polio Institute.

Therefore, Dr. Bruno established The Polio Survivors Fund to pay in full for evaluation and treatment for eligible polio survivors for those without medical insurance and for those not working who have medical insurance that does not provide out of network benefits. _For those with medical insurance who have not met their yearly deductible, The Polio Survivors Fund will pay up to the amount of the deductible. For those who cannot afford co-payments, The Polio Survivors Fund will pay applicable co-payments.

The POLIO SURVIVORS FUND

Eligibility Criteria: The Polio Survivors Fund financial eligibility criteria are based on the New Jersey Medicaid criteria for individuals with permanent disabilities and the Medicaid Buy-In criteria.

Income Guidelines: Social Security Disability Benefits/Railroad Retirement System Benefits received by the individual are not limited; earned income cannot exceed the federal poverty level which is currently $739/month for a disabled individual and $995/month for a couple; AND Unearned income (pensions, interest, private disability/retirement benefits, etc.) cannot exceed the federal poverty level which is currently $739/month for a disabled individual and $995/month for a couple This means an individual can earn up to $17,736.00 per year ($1,478.00 per month) in addition to Social Security Disability Benefits/Railroad.

Retirement System Benefits. Total maximum yearly income from all sources (including Social Security Disability Benefits/Railroad Retirement System Benefits) should not exceed $24,000.00 ($2,000.00 per month) for an individual.

Resource Guidelines: Assets must be $4,000 or less for an individual, $6,000 for a married couple. This does NOT include the value of a vehicle used for medical and/or work transportation or the home in which the individual/couple lives. Also excluded from the asset calculation are funds in a working spouse's IRA/401K account. Please send us your most recent IRS 1404 form, passbook copy or latest bank, brokerage account and checkbook statements.